BRIX ENTERPRISE
Customer Order Form

Please complete form below ... fill in all information.
Failure to fill in form completely will delay your order.
Then click the send button.
Payment By Credit Card, or Postal Money Order Only.

Paying with Postal Money Order fill out form then print it from web browser.
Then Mail Form with payment to;

Brix Enterprise
2721 State Hwy 23
Brook Park, Minnesota 55007
(320) 679-7024
U.S.A.

Return Policies
*E-Mail:
*Name:
*Address:
More Address:
*City:
*State/Provance:
Other State/Country:
*Zip Code:
*Country:
*Telephone:
*Motor Make:
*Motor HP:
*Motor Year:
*Model Number:
Serial Number:
Needed for Mercury Motors only.

Please Enter Your Credit Card Information Here.

Master Card Visa Card Discover Card
Card Number: --- Exp. Date - M/Y:
Security Number: This is the last 3 Numbers on the back of your card where the signiture is.
Name of Person as shown on Card:

Enter any other questions or information here:


Please Enter The Items You Wish To Order.

*Item Name *Stock Number *Price Ea. *Qty. *Total Cost
Minimum Shipping Charges.
Continental U.S.A. $10.95
Canada/Mexico $13.95
Over Seas Locations $20.00
Maximum 1 Lb. (16 oz.)
Additional cost of $2.00 per pound may be incurred for packages over 1 lb.
Most packages shipped United States Postal Priority Mail 3 Day Service
or Global Priority Mail where available. 		Select Shipping Cost
(MINIMUM COST)
Please Make Sure Form Is Completed Accurately. Thank You. *Grand Total

To find out the current bank exchange value of your currency to U.S. Dollars click on the Money Exchange button. To return to this page use the back button in your web browser.